Research Related to

Integumentary System
By Ita and Ryan

Hubungan stres dengan kejadian acne vulgaris pada

mahasiswa semester V program studi ilmu keperawatan
fakultas kedokteran universitas samratulangi manado
(Februari 2015)

PENDAHULUAN
Salah satu penyakit kulit yang banyak dijumpai
secara global pada remaja dan dewasa muda adalah
jerawat atau dalam bahasa medisnya disebut acne
(Yuindartanto, 2009).
Pertumbuhan acne vulgaris disebabkan oleh
berbagai faktor seperti genetik, endokrin (androgen
pituitary sebotropic), faktor makanan, keaktifan dari
kelenjar sebasea, faktor psikis, musim, faktor stres,
infeksi bakteri (Propionibacterium acnes), kosmetik
dan bahan kimia yang lain (Harahap, 2000).

...
Eksaserbasi acne ini disebabkan oleh meningkatnya
produksi hormon androgen dari kelenjar adrenal dan
sebum, bahkan asam lemak dalam sebum pun
meningkat (Harahap, 2000).
Pada beberapa penderita, stres dan gangguan
emosi dapat menyebabkan eksaserbasi acne.
Kecemasan menyebabkan penderita memanipulasi
acnenya secara mekanis, sehingga terjadi
kerusakan pada dinding folikel dan timbul lesi yang
beradang yang baru (Goggin et all, 2006)

...
Di Indonesia, acne vulgaris merupakan penyakit
kulit yang umum terjadi sekitar 85-100% kasus
acne. Acne vulgaris sering dijumpai pada wanita
yang berusia 14-17 tahun dan pada pria berusia
16-19 tahun (Yuindartanto, 2009). Menurut
catatan kelompok studi dermatologi kosmetika
Indonesia menunjukkan 60% penderita acne
vulgaris pada tahun 2006 dan 80% pada tahun
2007 (Effendi, 2003).

...
Berdasarkan data awal yang diperoleh di Program
Studi Ilmu Keperawatan memiliki jumlah mahasiswa
semester lima sebanyak 91 orang.
Setelah
diobservasi, sekitar 50% mahasiswa semester V
sedang mengalami jerawat (acne vulgaris)
kebanyakan belum mengenal kiat-kiat dalam
mengenali faktor-faktor penyebab timbulnya jerawat
salah satunya faktor stres.
Bila sudah menjadi
korban, barulah mereka cemas dan bingung akan
cara untuk mengobati dan menyingkirkan noda-noda
yang mencederai wajah yang dulu mulus dan halus.

...
Berdasarkan uraian di atas, maka peneliti
tertarik untuk meneliti hubungan stres
dengan kejadian acne vulgaris pada
mahasiswa semester lima Program Studi
Ilmu Keperawatan FK Unsrat Manado.

Tujuan penelitian
Untuk menganalisis hubungan stres dengan
kejadian acne vulgaris.

METODE PENELITIAN
Metode
analitik
dengan
menggunakan
pendekatan Case Control.
Populasi 91 orang.
Pengambilan sampel menggunakan probability
sampling yaitu simple random sampling.
Sampel 36.
Dilakukan pada mahasiswa keperawatan FK
Unsrat Manado tgl 9-11Des 2014.

...
Pengumpulan data berupa kuisioner DASS
(Depresion Anxiety Stress Scale) dengan 14
pertanyaan.
Data yg diperolah dianalisis dg komputer
dengan program SPSS dengan tahapan Editing,
Coding, Entry data, Cleaning.
Analisa univariat dilakukan thd setiap variabel
independen (stres) & variabel dependen (acne
vulgaris).

...
Analisa bivariat dilakukan untuk mengetahui
hubungan stres dengan kejadian acne
vulgaris
Uji statistik chi squere (X2) dg tingkat
kemaknaan 95% ( = 0,05), selain itu
dilakukan juga perhitungan Odds Ratio
(OR) (Wati, 2009) yg digunakan untuk
mengestimasi tingkat resiko antara variabel
dependen dg independen.

...
Dalam melakukan penelitian, peneliti
memperhatikan masalah-masalah etika
penelitian yang meliputi : Informed
Consent, Anonimity dan Confidentialy.

HASIL DAN PEMBAHASAN

HASIL ANALISIS UNIVARIAT dengan
karakteristik responden meliputi : JK, umur,
kategori stress, dan kategori acne vulgaris.
JENIS KELAMIN

PEREMPUAN
LAKI-LAKI

31
5

86,1
13,9

TOTAL

36

100,0

Tabel 5.1 Distribusi Frekuensi dan Presentase Responden Berdaasarkan Jenis kelamin

UMUR

18
18
20

1
12
23

2,8
33,3
63,9

TOTAL

36

100,0

Tabel 5.2 Distribusi Frekuensi dan Presentase Responden Berdasarkan Umur

KATEGORI STRES

TIDAK STRES
STRES

12
23

36,1
63,9

TOTAL

36

100,0

Tabel 5.3 Distribusi Frekuensi dan Presentase Responden Berdasarkan Kategori Stres
KEJADIAN ACNE
N
%
VULGARIS
TIDAK ACNE
ACNE

18
18

50
50

TOTAL

36

100,0

Tabel 5.4 Distribusi Frekuensi dan Presentase Responden Berdasarkan Kejadian Acne

HASIL ANALISIS BIVARIAT

KEJADIAN ACNE
KAT
STRES

STRES

ACNE

TIDAK ACNE

15

65,2

34,8

TOTAL

23

OR

100
0,001

TIDAK
STRES

23,1

10

76,9

13

100

Jumlah

18

50,0

44

84,6

36

100

Tabel 5.5 Crosstabulation Kategori Stres dengan Kejadian Acne vulgaris

6,250

SIMPULAN
Teridentifikasi lebih dari setengah (63,9%)
mahasiswa semester V (lima) Program Studi
Ilmu Keperawatan Fakultas Kedokteran
Universitas Sam Ratulangi Manado mengalami
stres. Separuh responden (50%) menderita
acne vulgaris pada mahasiswa semester V
(lima) Program Studi Ilmu Keperawan Fakultas
Kedokteran
Universitas
Sam
Ratulangi
Manado.

Occupational skin disease in nurses

(international journal of occupational medicine and
environmental health, 2003)

introduction
Skin disorders are one of the most frequent
occupation-related diseases. Work at the health
care sector is regarded as a risk factor for
developing occupational skin disease. Health care
workers are exposed to disinfecting materials,
different kinds of soap, detergents and latex. In
the USA, the highest incidence of occupational
skin diseases is encountered in health care
workers. The majority of occupational skin
diseases take form of contact dermatitis.

...
In Poland, the frequency of allergic contact dermatitis in
health care workers accounts for 25.6% of all
occupational pathologies, and in the former Soviet Union
only 13%.
According to the occupational diseases register in
Lithuania, only 1.9% of health care workers were
affected by this occupational pathology. Real situation in
Lithuania is quite different. Health care workers are
suffering from occupational skin diseases; working
conditions are stressful, and workers are exposed to
harmful biological and chemical agents.

MATERIALS AND
METHODS

The study population comprised a cohort of 706 nurses

working at Kaunas Medical University Hospital. The cohort
included nurses of various departments: therapeutical (305
nurses), surgical (270 nurses) and intensive care (131
nurses). The cohort was distributed by age to two large
groups.
Group I comprised 37.9% of women aged 2029 years.
Group II, 34.9% of women aged 3039 years. The rest of the
cohort was aged above 40 years. Length of service at medical
institutions was 11.6 years. Working time was divided into
intervals. The largest proportion of the study population
worked 78 h/day. The longest working hours were at
intensive care departments

 We conducted a follow-up by distributing a selfadministered questionnaire within each hospital

department.
The rate of questionnaire responses was 89%.
The data providing characteristics of the study
population: age, length of service, past and present
skin diseases, their localization and intensity were
collected.
Information concerning chemical materials and their
groups was obtained from a self-administered
questionnaire
and
chief-nurses
of
individual
departments. The subjects were consulted by
dermatologists to evaluate and diagnose skin
diseases. Diagnosis was established by anamnestic,
skin disease history and evaluation of data.

Statistical analysis
Odds ratio (OR) was used to measure the association between
outcome and exposure. We calculated the 95% confi dence
intervals (CI) on the basis of the Mantel- Haenszel test and
estimated adjusted odds ratios in logistic regression analysis.
We assessed the role of work environment factors, history of
atopy, working hours, length of service, and individual
protection measures. Exposure to chemical disinfecting
materials was established individually.
The prevalence of occupational skin disorders was compared
with groups of nurses, with or without occupational
exposure.engan kelompok perawat dengan atau tanpa
paparan kerja.

Result and discussion

Contact time with chemicals
<3h

3-6 h

7-9 h

>9h

Number of
nurses

Therapeutical

117 (38,4%)

106 (34,8%)

58 (19,0%)

24 (7,9%)

305 (100%)

Surgical

88 (32,6%)

79 (29,3%)

66 (24,4%)

37 (13,7%)

270 (100%)

Intensive Care

27 (20,6%)

48 (36,6%)

12 (9,2%)

44 ( 33,6%)

131 (100%)

Department

Contact time with chemicals

Departm
ent

Alcohols

Aldehydes

Hydrogenium
peroxide

Chlorine

Nurses

Nurses

Nurses

Nurses

Therape
utical

241

65,1

81

21,9

145

39,2

298

80,5

Surgical

150

72,8

50

24,3

134

65,1

177

85,9

Intensive
Care

117

90

12

9,2

80

61,5

112

86,2

DERMATITIS

NUMBER OF
CASES (%)

OR

95% CI

Allergic contact

161 (28,5)

17,3

10,4 26,8

< 0,05

Irritant contact

41 (8,4)

3,9

2,0 7,4

< 0,05

Cases
of nonallergic
disease
s

OR

95 %
CI

Sympto
ms

Cases
of
allergic

OR

95 %
CI

Vesicles

94

< 0,05

6,93

4,7-10,3

20

<0,05

1,95

1,1-3,5

Itching

123

< 0,05

5,92

4,0-8,7

25

0,19

1,46

0,8-2,6

Burning

30

< 0,05

3,75

2,1-6,7

0,46

0,64

0,2-2,1

Cracks

51

< 0,05

3,21

2,1-4,9

11

0,31

1,44

0,7-2,9

Dandruff

63

< 0,05

2,78

1,9-4,1

23

<0,05

0,73

0,1-5,6

Redness

124

< 0,05

6,03

4,1-8,8

30

<0,05

2,2

1,2-3,9

Pain

11

0,07

5,86

2,0-17,1

0,76

0,76

0,1-5,6

Symptoms appear

Skin allergic disease

(Allergic contact dermatitis)

Skin non-allergic disease

(Irritant contact dermatitis)

Cases

Cases

At the beginning to work

After 1-2 h
After 3-4 h
After 1-2 weeks

23
85
37
18

14,1
52,8
22,7
11,0

3
22
9
7

7,3
53,7
21,9
17,0

Total

163

100

41

100

Exposure
(h/day)

Nurses working with

chemical disinfecting
materials cases (%)

Skin disease (%)

1-2

219 (31,4)

80 (36,5)

3-6

223 (31,9)

118 (52,9)

7-9

126 (18,1)

61 (48,4)

>9

97 (13,9)

61 (62,9)

Chemicals

OR

95% CI

Alcohols

1,85

0,9-3,9

>0,05

Aldehydes

12,1

6,2-23,6

<0,05

Hydrogenium peroxide

7,03

2,4-20,5

<0,05

Chlorine

3,56

1,9-6,8

<0,05

Gloves wearing
duration
(h/day)

Nurses
working with
gloves

Cases of skin
demage

OR

95% CI

65

16

1-2

147

57

1,94

1,01 < OR < 3,7

<0,05

2-3

192

84

2,38

1,2 < OR < 4,5

<0,05

4-6

136

69

3,12

1,6 < OR 6,1

<0,05

>6

75

37

3,15

1,4 < OR < 6,2

<0,05

conclution
In the study population, 47.3% of nurses were suffering from
occupational skin diseases.
The highest incidence of these diseases was at intensive care
and surgical departments with longer working hours and more
contacts with chemical disinfecting materials.
The highest risk for skin damage was found in work with
alhehydes (OR = 11.3; CI = 6.220.08) and hydrogenium
peroxide (OR = 18.9; CI = 5.861.6).
Main symptoms of allergic contact dermatitis were redness,
rash, itching, vesicles, burning and dandruff. Nonallergic skin
diseases (irritant contact dermatitis) were manifested by rash
and redness.

...
Differential diagnosis between allergic contact dermatitis and
irritant contact dermatitis is complicated, because of lack of
data concerning skin disease history, symptoms, occupational
vs. domestic exposure.
Alhehydes and hydrogenium peroxide were mostly
responsible for the development of allergic skin diseases.
Intensive hand hygiene and use of latex gloves are
associated with the incidence of occupational skin diseases.
Work at intensive care units, use of aldehydes or
hydrogenium peroxyde, frequent handwashing, and long use
of latex gloves are the main risk factors of the occupational
dermatitis development in nurses.

THANKYOU FOR YOUR ATTENTION & GBU